Pathway by Which Oral Cancers Invade the Mandible

• To determine the need and extent of mandible resection:
  • It is essential to understand the pathway by which oral cancers invade the mandible
• Primary carcinomas of the lip, buccal mucosa, tongue, and floor of the mouth:
  • Extend along the surface mucosa and the submucosal soft tissues:
    • To approach the attached labial, buccal, or lingual gingiva
  • From this point:
    • The tumor does not extend directly through intact periosteum and cortical bone toward the cancellous part of the mandible:
      • Because the periosteum acts as a significant protective barrier
  • Instead:
    • The tumor advances from the attached gingiva toward the alveolus:
      • In patients with teeth, the tumor extends through the dental socket into the cancellous part of the bone and invades the mandible in that fashion (Figure)

• In edentulous patients:
  • The tumor extends up to the alveolar process and then infiltrates the dental pores in the alveolar ridge and extends to the cancellous part of the mandible (Figure)

 

• Thus even in patients with early invasion of the mandible:
  • A marginal mandibulectomy is feasible because the cortical part of the mandible inferior to the roots of the teeth:
    • Remains uninvolved and can be safely spared
• In edentulous patients, however, the feasibility of marginal mandibulectomy depends on the vertical height of the body of the mandible:
  • With aging, the alveolar process recedes and the mandibular canal comes closer to the surface of the alveolar process:
    • As shown in the Figure, the resorption of the alveolar process eventually leads to a “pipestem” mandible in elderly patients

• The ability to perform a satisfactory marginal mandibulectomy in such patients is almost impossible:
  • Because the probability of iatrogenic fracture or postsurgical spontaneous fracture of the remaining portion of the mandible is very high:
    • Similarly, in patients who have received previous radiotherapy, a marginal mandibulectomy should be performed with extreme caution:
      • The probability of pathological fracture at the site of the marginal mandibulectomy in such patients is very high
• When the tumor extends to involve the cancellous part of the mandible:
  • A segmental mandibulectomy must be performed
  • A segmental mandibulectomy also may be required in patients with massive primary tumors with significant soft tissue disease in the proximity of the mandible

• Rodrigo Arrangoiz MS, MD, FACS, FSSO is an Assistant Professor at the Columbia University Division of Surgical Oncology at Mount Sinai Medical Center
• He is first author on some publications on oral cavity cancer:
  • Oral Tongue Cancer: Literature Review and Current Management
    • https://www.oatext.com/pdf/CRR-2-153.pdf
  • Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management.
    • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Miami #Mexico